**5. Conclusions**

In conclusion, our preliminary results showed a reduction in the levels of pro-inflammatory cytokines in the overall study cohort and possibly an improvement in intestinal permeability and gastrointestinal symptoms in a subgroup of patients with IBS-D. Further randomized, double-blind, placebo-controlled studies are fundamental to validating the results of this pilot study on larger groups of patients with IBS-D.

**Author Contributions:** Conceptualization, A.T. and M.A.; Data curation, A.T. and R.P.; Formal analysis, D.G.R., and G.P.C.; Investigation, G.P.C., C.R., M.L.A., E.V., A.A. and A.O.; Methodology, A.T., M.A., D.G.R., R.P., E.V., A.A. and G.P.C.; Project administration, E.B., E.V., G.M.S. and M.A.; Software, D.G.R. and G.P.C.; Supervision, E.B. and G.M.S.; Validation, R.P. and S.F.; Visualization, E.V., R.P. and S.F.; Writing—original draft, A.T., G.P.C. and D.G.R.; Writing—review & editing, M.A., R.P. and S.F. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Acknowledgments:** The authors thank PharmExtracta S.p.a. for providing reagents for the measurement of serum cytokines and zonulin.

**Conflicts of Interest:** The authors declare no conflict of interest.
